Vapes of wrath: La Jolla doctor urges e-cigarette users to quit

Vaping cartridges and other supplies are openly advertised in a street-facing window along Pacific Beach's Garnet Avenue.

As the number of vaping-related deaths and illnesses mount — so far, 805 cases of vaping-related lung injury and 12 deaths have been reported, including two in California — health officials nationwide are imploring vapers to stop the practice.

As of Sept. 19, 18 San Diegans have been hospitalized with pulmonary complications related to vaping, according to the San Diego County Health & Human Services.

“I get called about quite a few,” said Laura Crotty Alexander, a pulmonologist and associate professor of medicine at UC San Diego, and a staff physician at the VA San Diego Healthcare System. “All the cases are very injurious to the lungs. All (the patients) are very hypoxic. They come in, they can’t breathe. Half the time, they have to come to intensive care. About one in four need to have a tube put in to help them breathe.”

Vaping is the use of an electronic cigarette (e-cigarette) typically loaded with a cartridge of liquid — containing either nicotine, THC (the psychoactive compound in marijuana) or CBD (the non-psychoactive compound in marijuana), flavoring and other additives — to heat and inhale a vapor at below the temperature of combustion (smoking).

One of vaping’s heavily marketed attractions is that it is healthier than smoking. And that may be, Crotty Alexander acknowledged.

“But just because they’re not burning it doesn’t mean that it’s safe,” she said. “The bottom line is that you’re inhaling 30 to 50 chemicals that your lungs were never meant to interact with. None of the chemicals in e-liquids has ever been tested for safety through inhalation.”

All these stores publicly advertise and sell vaping products on Garnet Avenue in Pacific Beach. Not one would grant ‘The Light’ an interview for this story.

It’s still not clear what exactly in inhaled vapor causes lung injury. For a few years now, e-cigarette vapor has been known to contain higher levels of toxic metals than even cigarette smoke, according to the U.S. Centers for Disease Control. However, the suspect that most researchers are zeroing in on now is THC.

The Centers for Disease Control and Prevention (CDC) found that 76.9 percent of sickened vape patients had used THC, while just 16 percent reported vaping only nicotine. (New York health officials are looking at the additive vitamin E acetate as a possible culprit, saying that high levels were detected in cartridges of marijuana vaping products.)

“We are hoping that it is a bad batch and there are hopefully clean forms of THC that don’t cause the problems,” Crotty Alexander said. “Hopefully, the FDA will come up with a clear answer in a couple weeks — although that might be wishful thinking.”

Until the answer is known, Crotty Alexander said, her message for marijuana vapers feels like “a weird thing to say.”

“Yes, it might be safer to smoke marijuana or eat edibles right now than it is to vape it,” she said. “My advice right now is to definitely not vape it. That’s what the data is showing so far.”

In La Jolla, only vaping products for nicotine are sold. Convenience and liquor stores — including 7-Eleven, Wine Time Deli, Dick’s Liquor, EM ExtraMile, Neighbor-Saver Market and the Shell Mega Mart — carry primarily the popular Juul brand, whose cartridges are about $20 and whose e-cigarettes are $50.

A much wider vaping selection is available in nearby Pacific Beach, where a whopping nine smoke shops (and one dedicated vape shop) sell both nicotine and THC vaping supplies on Garnet Avenue alone.

Perhaps tellingly, not a single owner or employee of those stores was willing to speak on the record when the Light entered their establishments to ask if and how the recent anti-vaping campaign has affected their business. However, one employee, who would not provide his name, accused the Light of pursuing this story only because “big tobacco is pressuring the government to attack vaping.”

“Why don’t you write about the dangers of smoking instead?” he asked. (When asked to respond to this accusation, Crotty Alexander said it made little sense because big tobacco actually owns over 80 percent of e-cigarette companies. “They’ve been working really hard to stop the FDA from regulating e-cigarettes,” she said.)

The smoke-shop employee also repeated the claim that vaping saves lives “because these people aren’t smoking.”

Crotty Alexander poked a hole in this argument, too. Studies show that most vaping consumers are not former smokers, she said. They’re people new to tobacco and marijuana. “And a lot of them are kids,” she said.

A sign on the Wine Time Deli's front door advertises the availability of a popular brand of e-cigarettes and cartridges.

Although the legal age for Californians to use either tobacco or marijuana products is 21, children have always been notorious for finding ways to get others to purchase age-restricted items for them. According to the CDC, there were 1.5 million more current youth e-cigarette users in 2018 than 2017, and 16 percent of vaping-related injuries occurred in users younger than 18.

“Based on epidemiology, our smoking rates were at an all-time low prior to e-cigarettes coming out, so it didn’t look like these kids would ever be smokers because the anti-smoking campaigns have been really successful,” Crotty Alexander said. “But because the vaping advertisements and social-media messages advertise them as being fun, sexy, cool and harm-free, a lot of kids have picked them up that never would have been smokers. Advertising on social media has been very appealing to them and so have the flavors.

“So now we have a new generation of nicotine addicts when we had done so well not to develop one previously.”

The Light intended to speak with vapers to see if recent warnings about the practice have altered their behavior, or even reached their awareness. However, none of the 10 Garnet Avenue stores had any customers inside of them at the time of our visit. (While the reason probably has more to do with 1:30 p.m. to 2:30 p.m. on a Tuesday not being peak business hours for vaping suppliers, it’s tempting to look upon this finding with at least some optimism for public health.)

The San Diego City Council, which next meets on Oct. 8, is reported to be considering a ban on sales of all vaping products — or at least on those sold in convenience and liquor stores.